Low Flow Bypass Using Radial Artery Interposition Graft for Symptomatic Chronic Common Carotid Artery Occlusion

Abstract

Summary: Cerebral revascularization is indicated for symptomatic chronic common carotid artery (CCA) occlusion. Although a variety of bypass surgeries have been reported, some of them are high-flow bypasses that carry the risk of hyperperfusion. In this article, we report two different low-flow bypass surgeries with radial artery graft, depending on the hemodynamics of CCA occlusion.Case 1 was an 82-year-old male who suffered right hemodynamic ischemic stroke with a large area of misery perfusion. Because of right distal internal carotid artery (ICA) occlusion, a left superficial temporal artery-right middle cerebral artery bypass was performed using radial artery (RA) interposition graft. This patient had a good outcome.Case 2 was a 74-year-old male who presented with intractable recurrent right cerebral ischemic stroke. Because the distal internal carotid artery was patent through collateral flow from the vertebral artery, ipsilateral thyrocervial trunk-RA interposition graft-ICA bypass was performed.Even though the bypass was successful, the patient's outcome was poor due to postoperative cardiac embolism.Bypasses using distal vessels of smaller caliber as donor pedicles, such as contralateral superficial temporal artery and thyrocervical trunk, can reduce hyperperfusion risk and make the procedure easier. Bypass patient selection and careful perioperative management are critical to obtain good clinical outcomes from these procedures.

A Case of Symptomatic Common Carotid Artery Occlusion Treated by a Bridging Bypass Using Short Saphenous Vein Graft

“…Once CCA occlusion becomes symptomatic due to hemodynamic cerebral ischemia or distal embolization from the occlusion site, it may be refractory to medical therapy. [2][3][4] Surgical treatment of symptomatic CCA occlusion should be considered and planned according to the cerebral hemodynamic conditions.…”